PWS Transitional Housing Services SPA 1268.docx

PERFORMANCE WORK STATEMENT (PWS)

CONTRACT RESIDENTIAL SERVICES BEDS:

Low Demand Safe Haven (LDSH) Model – Service Planning Area (SPA) 1-Lancaster Contract Emergency Residential Services (CERS) Model SPA 2 - Valley / SPA 6 - South Los Angeles / SPA 8 - San Pedro

1. PURPOSE.

1.1. The Department of Veterans Affairs has been providing direct and specialized services for homeless Veterans for over 25 years. The Secretary of the VA has set a zero-tolerance policy for homelessness within the Veteran population since 2009. The plan to end homelessness among Veterans includes planned increases to the capacity of existing programs and an increase in services offered to Veterans. New models of care not previously offered by The Veteran Health Administration are also being implemented.

1.2. The Department of Veterans Affairs Medical Center West Los Angeles requires contractors to provide transitional housing services as part of its community-based Health Care for Homeless Veterans (HCHV) Contracted Residential Services (CRS) program. The HCHV-CRS Program, an essential and critical part of Veterans Healthcare Administration, is vital for providing a gateway to VA Greater Los Angeles Healthcare System (VAGLAHS) and community supportive services for eligible Veterans who are homeless. This emergency transitional housing program is designed to address the needs of the most vulnerable and at-risk homeless Veterans.

It targets and prioritizes Veterans experiencing homelessness and are transitioning from literal street homelessness, being discharged from institutions, and/or who recently became homeless and require safe and stable living arrangements while they seek permanent housing. HCHV-CRS’s goal is to engage homeless Veterans in treatment and place them in a safe, sober and secure, emergency transitional housing that supports their rehabilitation goals. The model under the HCHV-CRS used for this contract will be:

1.2.1. Low Demand Safe Haven (LDSH) model located in SPA 1 - Lancaster, is a 24-hour staffed transitional residence with private or semi-private accommodations (no more than two (2) Veterans per room), that target the population of hard-to-reach, chronically homeless Veterans with mental illness and/or substance use problems who require a low-demand environment. The low-demand or non-intrusive environment is designed to re-establish trust and motivate the homeless Veteran to seek needed treatment services and transitional and permanent housing options. Lengths of stay in LDSH are typically six (6) months with the option to extend based on clinical need.

1.2.2. Contract Emergency Residential Services (CERS) model located in SPA 2 - Valley, 6 – South Los Angeles, and 8 – San Pedro, are contracts that target and prioritize homeless Veterans transitioning from literal street homelessness, Veterans being discharged from psychiatric and inpatient hospitalizations and Veterans who recently became homeless and require safe and stable living arrangements while they seek permanent housing. Lengths of stay in CERS typically range from 30 to 90 days with the option to extend based on clinical need.

1.3. Contractors shall provide housing, and supportive services to up to 10 Homeless Male Veterans each for SPAs 1, 2, and 6 and 20 Male Veterans for SPA 8. This emergency transitional housing contract shall be an “LDSH contract” located in SPA 1 - Lancaster catchment area and “CERS contracts” for SPA 2 - Valley, SPA 6 - South Los Angeles, and SPA 8 - San Pedro catchment areas.

Contractor shall offer a safe and secure environment that supports their goals for recovery from homelessness. Awards may be based on residential capacity to place Veterans in safe environmental residency. Maximum number of beds funded shall not exceed 3,650 bed days of care per year each for SPAs 1, 2, and 6 contracts and shall not exceed 7,300 beds days of care per year for SPA 8. The Contractor shall provide an on-demand, low-barrier therapeutic and rehabilitative milieu and attendant services targeting the underlying factors contributing to homelessness.

2. GENERAL CONTRACT REQUIREMENTS.

2.1. Same Day Access: Veterans may access transitional housing contracts via VAGLAHS consults from the HCHV Contracting Officer’s Representative (COR) Liaison, or directly to the contract by their outreach efforts and/or through referrals from the community. The contractor shall target Veterans who are engaged in care through a collaborative partnership among the VAGLAHS, the Los Angeles Coordinated Entry System Service Providers, Los Angeles Homeless Services Authority, and other Veteran-specific programs that target homeless Veterans.

2.1.1. Contractors shall complete an intake and SAME DAY admissions for those Veterans approved as eligible for placement by the HCHV COR Liaison or their designee or through direct Community Based referrals. The Contractor shall ensure their internal admission process and procedures allow for SAME DAY placement of accepted Veterans into an available bed. Admission shall occur up to 9pm during workdays (Monday – Friday, with the exception of federal holidays) and to 7pm on weekends and federal holidays.

2.1.1.1. The Contractor shall offer beds on the SAME DAY the referral is made by the designated HCHV COR Liaison or from direct Community Based referrals or eligible referring sources ie: VHAGLAHS or directly from Veterans.

2.1.1.2. HCHV COR Liaison will confirm eligibility prior to referral submission, during the work week and the Contractor’s staff shall complete a Status Query and Response Exchange System (SQUARES) review for all direct Community Based referrals.

2.1.1.3. The Contractor shall place Veterans into available beds on the same day of the approved admission whether referred by the HCHV COR Liaison or directly, if referrals are made before 9pm on workdays and 7pm on weekends, and space is available.

2.3 Criteria & Eligibility: The Contractor shall provide services to Veterans who are VA healthcare eligible and experiencing homelessness or at risk of becoming homeless, i.e., received an eviction or no longer able to reside at their existing housing situation.

2.3.1 Prior to admission into the program, Veterans shall be determined to be homeless based upon the McKinney-Vento Homeless Assistance Act definition by the local VA medical center HCHV CRS program. See Reference section.

2.3.2 Prior to admission into the program, Veterans shall be eligible for VA healthcare as determined by the local VA medical center and by the Contractor using SQUARES.

2.3.2.1 Veterans must be homeless and eligible for VA Health Care in order to be considered for admission to any HCHV CRS Program. Authorized HCHV COR Liaison or designee will be ultimately responsible for determining Veteran eligibility and approval for placement into a HCHV CRS Bed. Failure of the Contractor to establish VA approval for admission by the next business day may result in a denial of payment for services provided.

2.3.3 Veterans must be able to:

2.3.3.1 Actively engage in case management services on a weekly basis.

2.3.3.2 Actively engage in housing search.

2.3.3.3 Secure permanent housing.

2.3.3.4 Be Activities of Daily Living (ADL) independent.

2.4 Veteran Referral: Veterans are referred to the Contractor by VAGLAHS staff, other community agencies, the Contractor’s outreach efforts or Veteran self-referrals. The referrals shall be based on the Veteran’s demonstrated need for case management and supportive services to stabilize their mental health, substance abuse, medical and/or other co-occurring serious psychosocial issues before expediently transitioning into secure and permanent housing.

In addition to the above, the environment of an LDSH Contract considers those Veterans with criminal backgrounds, severe mental illness (SMI), or difficulty with sobriety to benefit from this contract. Additionally, those who have struggled with the environments of more structured sites. Veterans must actively participate in their discharge planning and be willing to seek permanent housing for placement consideration.

In addition to the above, the environment of a CERS contract considers those Veterans who need a jump start to get back on their feet. The environments are similar to shelters, with the added benefit of programming and case management. Veterans must actively participate in their discharge planning and be willing to seek permanent housing for placement consideration.

2.4.1 During the work week M-F 8am-3:30pm, both the VA HCHV COR Liaison(s) and the Contractor shall either receive consults (VAGLAHS referrals)/direct referrals (community or Veteran self referrals) and will complete the admission process for same day admission if Veteran meets the listed criteria and eligibility clauses listed above and their admission is not deemed unsafe for their milieu.

For after hours (3:30pm to 9pm), during the work week M-F and weekends, the Contractor shall continue to complete direct referrals. The Contractor shall be responsible to complete healthcare eligibility checks for placement.

2.4.3 When a Veteran is accepted for placement:

2.4.3.1 For HCHV Consults: the HCHV COR Liaison will ensure a Columbia-Suicide Severity Rating Scale (C-SSRS) is documented in the Computerized Patient Record System (CPRS) record by the referring party.

2.4.3.2 For Contractor’s Direct Referrals: the HCHV COR Liaison will be responsible for documenting the C-SSRS when meeting with the Veteran for their admission.

2.4.4 Outreach: Contractor’s staff shall engage in Outreach services, including street outreach efforts, assisting homeless Veterans in seeking housing placement, and treatment and supportive services which are key elements of this contract.

2.4.4.1 Outreach shall not include Contractor’s efforts towards “in-reaching” of services established from or by VAGLAHS i.e.: the welcome center or other VAGLAHS departments or other VAGLAHS resources and housing programs.

2.5 Contractor shall utilize the Housing First approach, with reduced barriers for contract entry. Veterans shall not be denied entry into a HCHV CRS contracts based solely upon length of current abstinence from alcohol or non-prescribed controlled substances, illegal substances, the number of previous treatment episodes, the time interval since the last Transitional Housing Program (THP) entry, the use of prescribed controlled substances, legal history or behavioral flag. See Denial of Services section.

2.5.1 Referrals shall be accepted (via VA, Community Partner, or Veteran) throughout the day, evening to at least 7:00 p.m., Monday – Friday, with the exception of federal holidays.

2.6 The Contractor shall rapidly house male Veterans requiring residential services and treatment at the VAGLAHS, addressing mental health, substance abuse and other psychosocial problems. Veterans must be ADL independent. Ultimately, the goal is for Veterans to actively search for and obtain permanent housing within 6 months under this LDSH contract model and within 90 days under the CERS contract models.

2.7 Liaison: A HCHV COR Liaison will be assigned to the Contractor who will act as the clinical HCHV COR Liaison between the Contractor and VAGLAHS.

2.7.1 The Contractor shall provide a private, nonshared office with adequate space for the HCHV COR Liaison to meet with the Veterans.

2.7.2 HCHV COR Liaison will be on site at the contract facility 3-5 days per week.

2.7.3 For Community locations/site, the Contractor shall provide parking for the HCHV COR Liaison.

2.8 The Contractor will not be required to provide detoxification or other hospital level treatment.

2.9 This emergency transitional housing shall be used exclusively for single males.

3. PERIOD OF PERFORMANCE. The period of performance for this contract shall be for a Base year and four (4) Option years.

4. CONTRACT TYPE. Firm Fixed Price Indefinite Delivery/Indefinite Quantity (IDIQ).

5. PLACE OF PERFORMANCE. The Contract’s location is crucial to ensure that Veterans can attend appointments scheduled in various VAGLAHS clinics or to local community providers and return to transitional housing with minimal barriers.

Space allotted for sleeping, eating, case management, and clinical services shall be provided by the Contractor within the SPA 1 / SPA 2 / SPA 6 / or SPA 8 catchment areas.

Regardless of location, the Contractor shall be required to attend frequent in person or virtual meetings with the West Los Angeles Medical Center located at 11301 Wilshire Blvd., Los Angeles, CA 90073 as scheduled by the VAGLAHS.

6. GOVERNMENT FURNISHED PROPERTY. Government furnished property will not be provided to the Contractor. All equipment and furniture required to fulfill this contract shall be provided at the Contractor’s expense.

7. CONTRACT AWARD MEETING. The Contractor shall not commence performance on the tasks in the awarded contract until the Contracting Officer or their representative has conducted a kick-off meeting or has advised the Contractor that a kick-off meeting is waived. The Contractor shall be fully operational between 30 and up to 90 days of the kickoff meeting or its waiver.

A list of authorized VAGLAHS Staff for the contract shall be provided to the Contractor upon award of the contract. VAGLAHS Staff may be added or deleted from the list during the term of the contract at the discretion of VAGLAHS HCHV CRS Section Chief or Supervisor. The Contractor shall be provided an updated list of authorized VAGLAHS Staff whenever such changes are made.

8. INSPECTION OF FACILITY AND REQUIRED SERVICES: Upon award of a contract and annually during the contract term, a multidisciplinary VAGLAHS team consisting of a Clinical social work team, dietitian, a representative of the VAGLAHS Police, a Facilities Management Safety Officer, Nursing and/or other subject matter experts as determined necessary by the medical center director or HCHV CRS Coordinator, shall conduct an inspection of the Contractor’s facilities to evaluate the Veteran’s food, shelter, safety, medication procedures and therapeutic services to assure the facility provides quality care in a safe and sober environment. Inspections may also be carried out at such other times as deemed necessary by the Department of Veterans Affairs.

Implementation of Timeline:

The contract facility and associated onsite services shall pass an initial inspection completed by VAGLAHS staff and become fully operational between 30 and up to 90 days from the date of contract award.

Contractor shall demonstrate successful completion of the following tasks, validated by VAGLAHS inspection prior to receiving Veteran referrals and invoicing for payment:

Identify a safe physical environment in a clinically appropriate setting for services to occur according to the PWS.

Between 30 and up to 90 days of kick off meeting or its waiver

Contractors shall participate in and adhere to the HCHV CRS inspection season. Contractors shall address and resolve all deficiencies found during the inspections before the season is complete or during ad hoc visits over the term of the contract. The Contracting Officer will be notified if any Contracted facility is not in compliance. For any deficiencies, a Corrective Action Plan (CAP) shall be developed by the Contractor and in collaboration with the HCHV COR Liaison; it shall indicate how the deficiencies will be resolved in a timely manner as agreed upon per the CAP. Facility inspections will be conducted at least annually but may be inspected more frequently.

8.1. The Contractor will be advised of any findings of the inspection team. If deficiencies are noted during any inspection, the Contractor shall attempt to resolve them immediately, however, will be given up to 30 days to complete corrective action and provide evidence to the inspection team that the CAP is monitored by of the deficiency resolution. Additionally, the HCHV COR Liaison will notify the Contracting Officer when the corrections have been made. For the initial inspection, the Contractor shall not admit Veterans until noted deficiencies have been resolved/eliminated.

Failure by the Contractor to take corrective action within 30 days, will be reported to the Contracting Officer. If corrections are not made to resolve or fix the deficiencies, the Contracting Officer will be notified in order to consult with the appropriate officials so that suitable arrangements can be made to discontinue plans to award a contract, or to discharge or transfer patients and to terminate the existing contract, as appropriate.

8.2. The inspection of the Contractor’s facilities will include inspection for conformity to the current Life Safety Code, and will include the following:

8.2.1. General observation of residents to determine if they maintain an acceptable level of personal hygiene and grooming.

8.2.2. Assessment of whether the facility meets applicable fire, safety and sanitation standards annually and ad hoc.

8.2.3. Determining if the facility is located in an area that is conducive to social interaction and the fullest development of the Veteran’s rehabilitative potential.

8.2.4. Observation of facility operations to see if appropriate organized activities are available during waking hours (including evenings) and degree to which a high level of activity is observed in the facility, such as individual professional counseling, physical activities, promotion of health and personal hygiene, continuously throughout the life of the contract.

8.2.5. Seeking evidence of facility-community interaction, demonstrated by the nature of scheduled activities or by information about resident flow out of the facility, e.g., community activities, volunteers, local consumer services, etc., continuously throughout the life of the contract.

8.2.6. Inspecting the types of meals and other nutrition provided to residents to see that nutritionally adequate meals are provided in a setting that also encourages social interaction and if nutritious snacks between meals and bedtime are available for those requiring or desiring additional food when it is not medically contraindicated.

8.2.7. Conducting random review of Veterans’ records to ensure accuracy with respect to Veterans’ length of stay and services provided to the Veterans.

8.3 The Contractor shall maintain current and valid licensure, certificates, permits, etc., of their contracted residential facilities when reviewing the furnishing, treatment, and rehabilitation services to eligible Veterans during any inspection and shall provide proof to the Department of Veterans Affairs inspection teams.

9. CONTRACT MONITORING. The HCHV COR Liaison or their designee will monitor the Contractor's performance. Performance deficiencies or poor performance identified during the term of the contract will be addressed with the Contractor. If determined appropriate, the Contracting Officer, HCHV COR Liaison and/or other VAGLAHS staff members shall meet with representatives of the Contractor to review performance and resolve issues; Corrective Action Plans may be required. See Performance Measure section.

10. METHOD OF INSPECTION AND ACCEPTANCE. The HCHV COR Liaison will evaluate all deliverables submitted. The HCHV COR Liaison or their representative is responsible for certifying invoices for payment only for deliverables received and deemed acceptable by the HCHV COR Liaison. The HCHV COR Liaison will evaluate the performance of the Contractor through formal quarterly and annual performance reviews. Failure to comply with this PWS could potentially lead to negative performance evaluation findings which could lead to premature contract termination if not corrected through a CAP.

11. SERVICES TO BE PROVIDED

11.1. Residential Services: The Contractor shall provide housing and supportive services to male Veterans under this contract which are required to ensure the safety and privacy of Veterans admitted.

TASK 1: HOUSING AVAILABLE FOR RAPID PLACEMENT

The Contractor shall be responsible for identifying sufficient residential capacity to safely support the placement of single male Veterans. This service shall include:

11.1.1. Timeliness of Response

HCHV CRS Consults: consults will be opened by the HCHV COR Liaison and responded to per the VA Standard Operating Procedures (SOP).

Direct referrals: Contactor staff, shall resolve direct referrals immediately and no longer than two (2) hours. Any call received from the VAGLAHS, between the hours of 8:00am-3:30pm, shall be deferred to the HCHV COR Liaison for HCHV CRS consult review.

11.1.2. Veterans shall be offered same day admission.

11.1.3. Contractor shall have sufficient personnel to assure security and safety, see Staff section.

11.1.4. Staffing shall be available 24 hours a day, 7 days per week, including holidays and weekends.

11.1.5. The Contractor shall allow Veterans to receive mail. The mail shall be kept secure until pick-up for Veteran. (At times, Veterans will need to receive medications by mail and/or important documents- all which ensure successful transition to permanent housing). The Contractor shall demonstrate practice to ensure Veterans access to mail including medications in a secure manner, see Medication section.

11.2. Subsistence:

The Contractor shall provide all food and beverages for Veterans residing at the facility to include three (3) meals per day and snacks. The Contractor shall maintain a clean and comfortable environment of care that includes subsistence meeting the following conditions:

11.2.1 Meals that meet the nutrition and dietary guidelines of the United States Department of Agriculture found at: https://www.choosemyplate.gov/.

11.2.2 Nutritious snacks between meals and at bedtime shall be available for those requiring or desiring additional food when it is not medically contradicted. All food shall be stored, handled, and served in a safe and sanitary manner that meets accepted industry standards and guidelines.

11.2.3 Contractor shall also provide reasonable accommodations for fulfilling special dietary needs, such as kosher, diabetic, allergies, medically indicated, vegetarian (including vegetarian preferences). Contractor shall ensure Veterans eating such an alternate diet are provided with complete nutrition.

11.2.4 The Contractor shall be responsible for all meals and the preparation of the meals shall meet the Department of Health standards. The Contractor shall ensure food is stored per requirements of Nutrition with regards to proper heating and refrigeration (warmer(s)/ice box or refrigeration units).

11.2.5 The Contractor shall provide tables and chairs, all eating utensils, cups, plates, bowls, and napkins. Contractor shall also provide trash receptacles and trash bags in the dining area and dispose of the trash after all meals.

12 Facilities Requirements.

12.1 The facility shall include a safe, secure, and readily available place for each Veteran to store belongings (e.g., a locking closet, a locking armoire, a wall or outside locker) chairs, tables, and locks if necessary.

12.2 Linens including sheets, pillowcases, towels, blankets, and pillows. The Contractor shall provide clean linens during a weekly linen exchange for all Veterans. Contractor shall have spare linens to replace linens requiring cleaning between regularly scheduled cleaning days.

12.3 Access to laundry facilities and supplies shall be free of charge and adequate for residents to do their own laundry or to have laundry done at minimum one (1) time per week. If providing on-site shared laundry: A laundry facility shall include a minimum of one (1) washer and one (1) dryer for every 10 Veterans provided on-site. Laundry service to include water, electricity, etc., shall be provided at no cost to authorized Veterans.

12.3.1 The Contractor shall be fully responsible for the unit’s maintenance, upkeep, and care. The Contractor shall provide adequate amounts of laundry detergent. Hypo-allergenic detergent may be required for medical reasons as prescribed.

12.3.2 If equipment breaks down, the Contractor shall provide alternate weekly arrangements at community laundry facilities until in house services are operable; the Contractor shall provide transportation for any Veteran in need to and from.

12.4 The Contractor shall provide health and personal hygiene supplies for Veterans throughout their stay (i.e., dental products, hair products, soap, shave products, deodorant products, minor first aid products, etc.).

12.5 Contractor shall maintain a clean and comfortable environment of care that meets the conditions stated herein. Contractor shall bear all costs associated with ensuring compliance with these requirements. Contractor shall ensure that it has sufficient operating funds to maintain the facility according to the requirements of this contract.

12.6 Room inspections, including methods and frequency.

12.6.1 Regular room checks shall occur with a strong focus on maintaining a safe environment that promotes the wellbeing of all residents. Increased room checks and safety planning for Veterans determined to be high-risk is required with supporting documentation.

13 SAFE ROOM:

13.1 The Contractor shall:

13.1.1 The Contractor shall have a “Safe Room” for Veterans who enter the facility inebriated or exhibiting or engaging in behaviors requiring their separation from the general population. Those Veterans shall be kept separate from the other Veterans to allow for sobering/quiet time until they have been cleared to return to the general population of the Contracted Residential Service Program.

13.1.2 The Contractor shall ask inebriated Veterans who enter the contract to provide a urinalysis (UA) or breathalyzer for documentation purposes. If the Veteran refuses to provide the UA, the Contractor shall not refuse services to the Veteran.

13.1.3 The Contractor shall determine if the Veteran is in need of immediate emergency services for medical attention. If medical attention is required, the Contractor shall call 911 and contact the HCHV COR Liaison by telephone during business hours. For afterhours an email shall be sent to the HCHV COR Liaison for notification. The Contractor shall complete a VA Incident Report and forward it to the HCHV COR Liaison, see Critical Incident Report section.

13.1.4 The Contractor shall place the Veteran in the Safe Room if determined that the Veteran is not in need of immediate medical attention.

13.1.5 The Contractor shall monitor Veterans who are placed in the “Safe Room.” Veterans shall be physically checked every 30 minutes during the first 12 hours. Close observation and physical checks shall continue beyond the initial 12-hour period for as long as the Veteran appears inebriated. Documentation of physical checks should be maintained with a brief description of Contractor’s observations in the Veteran’s record. As needed, the Contractor shall conduct a re-assessment, urinalysis and/or breathalyzer to determine appropriateness of Veteran’s return to the general population of the Contracted Residential Service Program.

13.1.6 In all cases relating to signs of withdrawal and/or acts of violence, Contractor’s staff shall contact the local emergency response system- 911 for assistance and contact the HCHV COR Liaison by telephone during business hours. For afterhours an email shall be sent to the HCHV COR Liaison for notification. The Contractor shall complete a VA Incident Report and forward it to the HCHV COR Liaison, see Critical Incident Report section.

13.1.7 For admissions purposes, the safe room shall not be used as an assessment or bridge setting for same day admitted Veterans.

13.1.8 The safe room shall be furnished with the following:

13.1.8.1 One (1) single bed.

13.1.8.2 Proper bedding, i.e., fitted sheets, blankets, pillows.

13.1.8.3 Immediate accessibility to restroom facilities.

13.1.8.4 Immediate accessibility to staff in case of emergency.

14 Janitorial Services. The Contractor shall manage daily cleanliness of the entire temporary housing facility, including bathroom, shower, dining facilities, sleeping areas, and all common areas. The Contractor shall also ensure the outside of the facility, within a 30-foot perimeter, is kept clean and free from debris. The Contractor shall provide daily trash removal from the trash receptacles inside and outside the facility. The Contractor shall empty trash receptacles when they are full regardless of when daily trash service is scheduled. The Contractor shall provide cleaning supplies to accomplish daily cleanliness. The HCHV COR Liaison will inspect the facility for cleanliness and report deficiencies to the Contractor and VAGLAHS.

15 Transportation. The Contractor shall provide transportation for Veterans to attend appointments at or off campus of the VA Medical Center (including local VAGLAHS clinic or community providers), and appointments for potential housing placements, benefits agencies, and meetings with landlords. The Contractor shall help Veterans access public transportation, including providing information and instructions necessary to enable Veterans to utilize public transportation. Transportation services may include assistance in obtaining Metro-cards, bus fare, or local subsidized transportation services such as Access, Lyft, etc., however if transportation services described above are not in place or until in place, the Contractor shall be responsible for providing transportation services. If VAGLAHS staff determines that adequate public transportation is not available or appropriate for a Veteran, the Contractor shall arrange for alternative transport by car or taxi at Contractor’s expense.

16.1.1 Structured group activities, as appropriate, shall occur at least ten (10) times per month for LDSH model contract and four (4) times per month for CERS model contracts– examples include group therapy, life skills training, social skills training, financial workshops, Alcoholics Anonymous, Narcotics Anonymous, vocational counseling, and physical activities as appropriate.

Should a Veteran have mental health, medical, family and/or employment obligations which directly conflicts with this requirement, alternate group activities shall be arranged and/or the Contractor shall clearly document efforts made to accommodate the Veteran. Contractor shall coordinate provision of group activities with the HCHV COR Liaison. Groups shall have sign in logs and brochures or other materials of what was discussed; these should be saved for the HCHV COR Liaison’s review.

16.1.2 Contractor shall facilitate a “House Meeting” once per month. For the purposes of this contract “House Meetings,” (or VAGLAHS Housing Resource Groups) may not be counted as a structured group activity as the House Meeting shall have a therapeutic value and facilitation shall be the responsibility of the Contractor. Also, the House Meeting shall be converted to a monthly newsletter/flyer to include updates and information provided during the monthly House Meetings to the Veterans in the event of a pandemic or social distancing is required and shall be distributed to the Veterans.

16.2 VAGLAHS Coordination: The Contractor shall collaborate and coordinate with VAGLAHS staff, as needed, to include coordination of supportive psychosocial services and housing. In particular, coordinated efforts shall be made with the HCHV COR Liaison around medical, mental health, admission and discharge needs.

16.3 Case Management: The Contractor shall include structured individual case management, at minimum, weekly including counseling on self-care skills, adaptive coping skills, financial planning, permanent housing search, written care plan, referral for financial benefits. Additional counseling may include professional and vocational rehabilitation counseling in collaboration with VAGLAHS programs and community resources.

Discharge planning shall begin at time of admission and reviewed at least monthly.

A thorough written Individualized Service Plan (ISP) shall also be developed within one (1) week of admission for each Veteran placed in residential services and shall be updated every 30 days thereafter until discharge.

ISPs are developed through a joint effort with the Veteran, the Contracted provider, and the HCHV COR Liaison. ISPs shall be developed for each Veteran, by the Veteran and in collaboration with and based upon input from HCHV CRS contract staff assessments, and other VAGLAHS clinical data. ISPs shall reflect Specific, Measurable, Action-Oriented, Realistic, and Time-bound (SMART) goals.

In addition, for High Suicide Risk (HSR) Veterans identified by the HCHV COR Liaison, VAGLAHS Mental Health Staff, the Contracted case manager, or from a CPRS flag, the Contractor shall:

16.3.1 On a weekly basis, the Contracted case manager shall be required to update the HCHV COR Liaison on Veteran progress and/or safety concerns for HSR Veterans.

16.3.2 Contracted case manager shall review the HSR Safety Plans with the Veteran on a bi-monthly basis. HSR Safety plan reviews and a copy of the Veteran’s Safety Plan shall be documented in the Veteran’s program chart.

16.4 All Veterans shall be referred to VAGLAHS for Primary Care and Mental Health appointments and the Contractor shall support Veterans in making initial and subsequent appointments. Efforts shall be documented in the Veteran’s contract records and reviewed by the HCHV COR Liaison at least monthly. If the Veteran refuses such referral, the Contractor shall assist the Veteran with appropriate community-based services and documentation efforts and appointments within the Veteran’s Contract Record.

16.4.1 All Contractors shall provide proper documentation verifying services and case management efforts by all team members including, but not limited to housing, benefit and employment specialists, and contract management staff.

16.4.1.1 Notes shall be written in a professional manner, in a format that utilizes the clear settings of goals and documents progress towards those goals.

16.5 The Contractor shall provide treatment and discharge planning reflecting a team assessment of health, social and vocational needs and the involvement of the Veteran, VAGLAHS services and supports and appropriate community resources in resolving problems and setting goals.

16.6 Case Conference: The Contractor shall provide HCHV COR Liaison with regular reports on changes in Veteran’s status, including all changes and observations concerning the Veteran’s needs, on a monthly or as needed basis.

16.7 Permanent Housing Search: Contractors shall provide Veterans with direct and ongoing assistance in achieving permanent housing. Permanent Housing is a primary goal of the HCHV CRS contracts, therefore plans for Veterans’ transition to permanent housing placements shall be clearly reflected in each ISP and in weekly case management notes.

16.7.1 As part of this plan, Veterans’ housing history and needs shall be assessed through a formal and thorough Housing Assessment completed within three (3) business days of contract admission. Housing Assessments shall identify Veterans’ housing history, strengths (i.e. positive prior rental history), and barriers (i.e. Unlawful Detainers).

16.7.2 Should Veteran refuse to engage with contract staff regarding plans for permanent housing transition, motivational interviewing and other therapeutic techniques shall be used to address Veteran’s ambivalence.

16.7.3 All efforts to engage Veteran regarding housing plans, options, and resources shall be clearly documented and include any therapeutic techniques utilized. Contractor staff shall provide direct assistance to Veterans in developing permanent housing plans and accessing appropriate housing resources. It is expected that as part of their housing plan, Veterans shall be co-enrolled in either Housing and Urban Development VA Supported Housing (HUD-VASH) or Supported Services for Veteran Families (SSVF)/Rapid Rehousing services.

16.7.3.1 These services shall be provided weekly through one-to-one case management. Examples of expected housing services include:

16.7.4 All housing efforts made by the Contractor shall be documented clearly and presented to HCHV COR Liaison upon request.

16.7.5 Mere communication with Veterans regarding housing, without subsequent Contractor staff documented action and follow-up, shall not on its own meet the above requirements.

16.8 Financial Planning: Referral to and follow up on all potential financial resources the Veteran may be eligible for (e.g., Supplement Security Income (SSI), Social Security Disability Insurance (SSDI), Food Stamps, Non-Service Connected (NSC) pension, General Assistance (GA), etc.).

16.8.1 Case Managers (CM) shall document all structured activities that support Veteran in developing a short and long-term plan to understand and address their current financial situation and how to improve it. Financial planning efforts may be accomplished in group but preferably through one-on-one case management services.

16.8.1.1 At minimum, four (4) financial planning activities, appropriate to the Veteran’s individual circumstance shall be documented monthly.

16.8.1.2 Veterans with no income, shall be referred to Department of Public Social Services (DPSS) for General Relief and food stamps immediately but no more than two (2) weeks of admission.

16.8.1.3 Veterans with no income or limited income, the Contractor’s CM shall explore their interest in increasing their income through employment, or benefits claims Social Security Income/Social Security Disability Insurance (SSI/SSDI and/or Service Connected/ Non Service Connected (SC)/NSC).

16.8.1.3.1 If a Veteran is ineligible for employment, the CM shall initiate a claim for benefits with the Veteran immediately but no more than 30 days from their admission.

16.8.1.4 Veterans shall be encouraged to save any income after addressing their bills.

16.8.1.4.1 Veterans shall be encouraged to show proof of savings and its accumulation.

16.8.1.4.2 Veterans shall initiate a savings plans equal to their potential rental liability and move in cost.

16.9 Employment Services: Referrals to all relevant employment opportunities the Veteran is eligible for and interested in, the CMs shall document all structured activities that support Veteran in applying for employment as appropriate based on needs of Veteran as identified in the assessment.

16.10 Recovery: The Contractor shall support Veterans in an alcohol/drug abuse-free lifestyle provided in an environment conducive to social interaction and the fullest development of the resident’s rehabilitative potential. The Contractor shall assist Veterans to gain and apply knowledge of the recovery process in an environment supportive of recovery models including a focus on Harm Reduction rather than strict abstinence and supportive of a Housing First approach. Pursuant to these principles, drug testing shall not be used to discharge or discipline a Veteran but may be used as a clinical intervention to modify behavior.

16.11 Critical Incidents: The Contractor shall notify the HCHV COR Liaison immediately of any incidents involving Veterans residing in the HCHV CRS program.

16.11.1 The Contractor shall notify the authorizing HCHV COR Liaison immediately, but no later than within 24 hours when a medical emergency occurs that requires hospitalization of an admitted Veteran. The Veteran shall be admitted to the appropriate VAGLAHS facility. When such admission is not feasible due to the nature of the emergency, hospitalization in a non-federal facility is acceptable. If hospitalization of a non-emergent nature is required, admission to the appropriate VAGLAHS facility shall be accomplished by the Contractor. The Contractor shall make arrangements for admission and support the Veteran with any transportation issues that may arise.

16.11.1.1 The Contractor shall notify the HCHV COR Liaison by telephone during the hours of 8am to 4:30pm. For all incidents that occur after normal business hours, the Contractor shall notify the HCHV COR Liaison the following business day. The Contractor shall provide the HCHV COR Liaison a copy of the incident report within 24 hours or the next business day if on a weekend or federal holiday.

16.11.2 Critical Incident & Incident Reporting: All incidents shall be reported within 24 hours or the next business day (if on a weekend or federal holiday). The Contractor shall complete the incident form and forward, in an encrypted email, to the assigned HCHV COR Liaison or their designee. The form shall have details as to what occurred and what were the interventions. Reportable incidences can include the following:

16.11.2.1 Falls

16.11.2.2 Assault (to Veteran or Staff)/Fights

16.11.2.3 Elderly/Dependent Adult Abuse or Neglect

16.11.2.4 Sexual Assault

16.11.2.5 Fire (Veteran Involved)

16.11.2.6 Medical/Psychiatric Emergency (911 Calls)

16.11.2.7 Hospitalization

16.11.2.8 Suicide or Suicide Attempt

16.11.2.9 Homicide

16.11.2.10 Death

16.11.2.11 Infectious Control (TB, etc.)

16.11.3 Death: In the event a Veteran residing in the HCHV CRS program under this contract dies, the Contractor shall promptly notify the HCHV COR Liaison authorizing admission and immediately assemble, inventory, and safeguard the Veteran’s personal effects. The funds, deposits, and effects left by Veterans upon the premises of the facility shall be delivered to the person or persons entitled thereto under the laws currently governing the facility for making disposition of funds and effects left by Veterans, unless the beneficiary died without leaving a will, heirs, or next of kin capable of inheriting.

When disposition has been made, the itemized inventory and a notation as to when the disposition has been made, shall be immediately forwarded to the HCHV COR Liaison. Property and funds wherever located vests in and becomes property of the United States in trust. In these cases, the Contractor shall forward an inventory of any such property and funds in its possession to the appropriate VA office and shall hold them (except articles of clothing necessary for proper burial) under safeguard until instructions are received from the VA concerning disposition.

16.11.4 The Contractor shall maintain a copy of any incident report in the Veteran’s case record. Please see above in reporting for details regarding what constitutes a Critical Incident or Incident.

16.12 Medication Management: Medications that a Veteran brings into the facility or is prescribed while in the care of the Contractor, shall be managed in accordance with the following:

16.12.1 Medications and narcotics shall be properly stored, controlled, issued, and recorded in compliance with physician’s orders. Contractor shall establish procedures for insuring Veterans confidentiality in the storage of and keeping of records concerning medication. Medications that a Veteran brings into the facility or is prescribed while in the care of the Contractor shall be managed in accordance with the following:

16.12.1.1 All medications shall be surrendered to the Contractor for storage and maintenance, unless clinically indicated to be carried on the Veteran’s person. All controlled substances shall be surrendered/stored by the Contractor.

16.12.1.2 Medications including but not limited to controlled substances shall be properly stored and controlled in a double locked storage unit, unless clinically indicated to be carried on the Veteran’s person.

16.12.1.3 Contractor shall provide a centralized area to store medications and maintain logs for all received medications stored by the contract on behalf of Veterans.

16.12.1.4 Contractor shall have a written policy regarding the use of prescribed medications by admitted Veterans. Such policy shall not preclude the illicit use of prescribed medications.

16.12.1.5 All medication shall be self-administered by the Veteran and monitored by Contractor’s staff during posted hours and as prescribed by physician’s orders. Veteran shall initial the Contractor’s medications log upon self-administering medication to verify the count of medication.

16.12.1.6 Contractor shall include in their policy, measures taken for Veterans who are prescribed medication(s) but will be gone during posted hours.

16.12.1.7 Contractor shall maintain copies of any medical prescriptions issued by VA physicians or VA providers licensed to prescribe medications or community providers, including orders, if any, for medications to be taken.

TASK 3: DELIVERY OF SUPPORT SERVICES

17. Referrals, Admissions and Eligibility: The Contractor shall utilize an admission process that includes written eligibility criteria that is fair, objective, and compliant with applicable State and Federal laws.

The Contractor shall provide verbal and written notification that is readily accessible to all Veterans, upon request, of reasons for non-acceptance. Notification of reasons for non-acceptance is not required to be given to those denied service/housing because of bed unavailability. The eligibility information shall be made available to Veterans at intake and staff shall provide answers to questions about the admission criteria and process.

17.1 The VAGLAHS will be responsible for determining eligibility and admission of Veterans during the work week, however Contractor staff shall perform SQUARES to determine eligibility for all direct Community Based referrals. For direct Community Based referrals, the Contractor shall be responsible for printing the SQUARES search result and storing it in the Veteran’s contract chart if deemed eligible for admission. Release of Information (ROI) can be verbal and at the time of the referral and a written ROI can be completed once the Veteran presents to the contract once admitted. Tuberculosis (TB) test can be addressed post admission, if not ordered prior.

Any admissions that occur without eligibility approval, i.e., after hours or weekends shall be verified by the HCHV COR Liaison within 24 hours or the next business day in order for the Contractor to receive payment for time spent prior to approval (e.g., admission after hours or during the weekend).

17.2 Admissions Process: During the admissions process, the HCHV COR Liaison will determine eligibility and appropriateness for placement into this HCHV CRS housing contract during business hours. The HCHV COR Liaison will notify Contractor staff of a Veteran’s approved placement and notification of their arrival via email.

The Contractor staff shall register with SQUARES in order to gain access to determine eligibility for any direct and community referrals. If the Contractor subsequently determines the Veteran is not suitable for the available level of care offered in the contracted THP environment, the Contractor shall notify the referring community staff to continue their placement search for the referred Veteran immediately, but no more than two (2) hours. The Contractor shall make every effort to minimize access barriers into the contract; flags or multiple THP admissions/discharges shall not be reasons to not consider Veteran placement acceptance.

17.3 Denial of Services: If a bed is available, Veterans shall not be denied entry by the Contractor if the Veteran has been approved and deemed eligible by HCHV COR Liaison, unless the Veteran requires care above and beyond the scope of contract practice.

17.3.1 Veterans shall not be denied entry into this contracted THP for flag concerns or multiple admission/discharges to THP.

17.3.2 Acceptance of treatment cannot be a condition of admission or continued stay.

17.4 Placement considerations. Infractions of rules shall be used as opportunities for engagement.

17.4.1 Contractor shall train their staff in providing flexible, respectful responses to infractions of rules.

17.4.2 The Contractor shall practice assertive engagement as the preferred course of action to deal with the common problems of the Safe Haven model/facility.